The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Monday, October 05, 2009

Huge physiotherapy waiting list in Scotland

Government challenged over ‘shameful’ figures showing 20,000 sufferers without treatment

The Scottish Government came under fire yesterday after it emerged that more than 20,000 people across Scotland are on NHS waiting lists for physiotherapy. The Conservatives said immediate action was needed to reduce the numbers to help patients to recover from illness more quickly. Party health spokeswoman Mary Scanlon challenged Public Health Minister Shona Robison on the figures at Holyrood yesterday. Information released under freedom of information laws showed that 3,661 people in the NHS Tayside area are waiting for treatment.

Some 1,340 people are on NHS Highland waiting lists, 120 in Orkney and 127 in the Western Isles. No figure was available for Shetland. NHS Grampian said only certain hospitals recorded how many people are on waiting lists and gathering all the data would be too costly under freedom of information guidelines.

Chief executive Richard Carey revealed that, of the hospitals that do keep records, 384 patients are on waiting lists. Some 245 of them are waiting for treatment at Dr Gray’s Hospital in Elgin where the average waiting time is 14 weeks.

Ms Scanlon, a Highlands and Islands MSP, said: “Not only is it shameful that the Scottish Government has no record of these figures but when I did uncover the figures, they were truly shocking. “Over 20,000 people across Scotland, many of them in pain, are waiting to see a physiotherapist. “The SNP manifesto promised to reduce waiting times for physiotherapy but they can’t even tell us if they have done that. “Yet another group of people have been let down by yet another broken promise from Alex Salmond’s SNP.”

North-east Tory MSP Nanette Milne has called on NHS Grampian to collect reliable information in the future to build up a clear picture of the problems being faced.

Ms Robison told MSPs that, under the SNP, waiting times were coming down in general, a trend only made possible if physiotherapy waiting times are being reduced. The Dundee East MSP said the number of physiotherapists working within the NHS had increased by 4% in recent times, which should be welcomed. Ms Robison said: “We are aware waiting times do vary in different parts of the country but work is ongoing within boards to standardise processes, resources and practice. “We are currently funding a two-year project to capture data on workload activity which will meet that data gap.” Ms Robison said the government is “working very hard” with the NHS to identify new ways of working to improve patient care.

The NHS is letting down women with breast cancer by offering less than half of sufferers the chance to have reconstructive surgery immediately after a mastectomy, an official report reveals.

Just 48% of women with the disease were offered the option of reconstruction in 2007-08 even though National Institute for Health and Clinical Excellence guidelines say it should be 100% of eligible patients, according to the National Mastectomy and Breast Reconstruction Audit.

Only 21% of breast cancer patients had an immediate reconstruction, it found. While that is up on the 11% recorded the previous year, there are concerns that wide variations in the numbers undergoing surgery in different parts of England and Wales suggest that doctors need to improve how they talk to women about their options for treatment after having a breast removed.

The study also found that five of the NHS's 30 regional cancer networks in England lack the expertise to offer women undergoing a mastectomy reconstruction either locally or quickly.

Breast cancer is the commonest form of cancer in the UK. Some 45,400 women a year are diagnosed with it and it kills almost 12,000 annually. Although treatment and chances of survival have improved, more women are being diagnosed with it. The number of women having a breast cancer operation rose from 24,684 in 1997 to 33,814 in 2006 – a 37% rise.

Most women with breast cancer have a mastectomy. Nice says that all who do are meant to be offered immediate reconstructive surgery, unless they are medically unfit to withstand the operation or are having chemotherapy or radiotherapy.

Robin Burgess, of the Healthcare Quality Improvement Partnership, a collaboration between medical royal colleges which aims to drive up standards of care, said: "This is a failure to offer patients the choice they are entitled to, one for which they should have access to better information. Patients have a right to be treated as equals in their choice of treatment." Offering women immediate reconstruction can minimise the psychological impact of a mastectomy and reduce the number of operations needed, he added.

Jane Hatfield, of the charity Breast Cancer Care, said: "There has been some improvement in the number of women offered immediate reconstruction; however, it is unacceptable that the majority are still not given this option."

The report, published by the NHS Information Centre, recommends the health service improves its performance on breast cancer care in six areas, including a "review of the way in which the offer of reconstruction is communicated to ensure barriers to women accepting the offer are minimised".

The actions of the hospital staff do seem extraordinarily negligent. In a private hospital they would not have stopped until they found the cause of the problem

A TEENAGER who had part of her skull removed as a result of bacterial meningitis is suing the State of Queensland, claiming a public hospital sent her home four times without diagnosing the infection. Sharna Gallagher, 18, is seeking more than $337,000 in personal injury damages, alleging negligence by Kingaroy Hospital staff.

Ms Gallagher was almost 16 when she first went to the hospital on January 10, 2007, complaining of severe pain in her right ear, with associated bleeding, headache and general pain. In her claim filed in the Supreme Court in Brisbane last month, Ms Gallagher alleges medical staff who saw her failed to diagnose a severe infection, refer her to a specialist or order tests.

It is alleged that Ms Gallagher returned to the hospital over the next two days but was not seen to and then sent home. Ms Gallagher claims that when she went back to the hospital on January 14, she had extreme ear pain and bleeding, fever and rigor, headache and back pain, and was seen by staff but again sent home. On her return to the hospital just over a week later, staff transferred her to Toowoomba Base Hospital, where she was diagnosed with bacterial meningitis and middle ear infection.

Ms Gallagher underwent surgery at Brisbane's Princess Alexandra Hospital two days later and remained in hospital undergoing treatment for more than a month. Part of her skull was permanently removed, and it is claimed she suffered conductive hearing loss, ongoing ear infections, scarring and also a related major depressive disorder.

In her claim to the court, it is alleged Ms Gallagher was unable to finish school, return to her casual job at a fast-food outlet or undergo career training because of physical pain, ear problems and psychological injuries. Ms Gallagher claimed she would require further medical treatment, including surgery to repair her skull and ear drum, and ongoing psychological counselling.

Queensland Health said it could not comment as the case was before the court.

Democrats don't believe in identity fraud -- or is it that they want to encourage it?

Americans expect to show a photo ID when they board a plane, enter many office buildings, cash a check or even rent a video -- but rarely in voting or applying for government benefits such as Medicaid. Many Democrats seem to view asking citizens for proof of identity as an invasion of privacy -- though what's really being protected is the right to commit identity fraud.

Exhibit A is Tuesday's 13 to 10 party-line vote in the Senate Finance Committee rejecting a proposal to require that immigrants prove their identity when signing up for federal health care programs. Chuck Grassley, the ranking Republican on the committee, said current procedures make it easy for illegal immigrants to use false or stolen identities to get benefits. But he ran into a buzz saw of opposition. Democratic Sen. Jeff Bingaman of New Mexico insisted such fraud was too rare to be worth worrying about: "The way I see the amendment, it's a solution without a problem."

Mr. Grassley admits to being "very perplexed as to why anyone would oppose this amendment." So does Senator Tom Coburn, one of the only two physicians in the Senate. He cites studies suggesting that fraud will cost Medicare and Medicaid about $100 billion this year. Harvard's Dr. Malcolm Sparrow, author of the book "License to Steal," estimates that the losses could easily be higher -- as much 20% or 30% of the trillion-plus dollars of spending represented by Medicaid and Medicare.

You'd think Senate Democrats would be interested in finding out just who is committing that fraud. But Tuesday's vote puts them firmly in the "see no evil, hear no evil, speak no evil" camp when it comes to the misuse of taxpayer dollars.

Among the $500 billion in Medicare cuts that will provide the bulk of the financing for Obama's health care plan is a $160 billion to $180 billion cut in the Medicare Advantage program, which offers a range of benefits not available to beneficiaries under basic Medicare.

Medicare Advantage should be Obama's favorite program. It combines all the elements he likes -- premiums are subsidized for low-income elderly, and the companies negotiate low-priced, managed care that emphasizes prevention, treatment of chronic conditions and coordination among doctors. As a result, its costs on the one hand and its premiums on the other are both much lower than with conventional insurance.

Medicare Advantage, which gained momentum during the Bush-43 years, essentially implements all the economies and efficiencies that Obama preaches nonstop. Doctors speak to one another, duplication is avoided, care is managed, and there is an emphasis on prevention.

The alternative to Medicare Advantage is Medicare supplement plans, popularly called Medigap coverage. But these conventional health insurance policies offer fewer benefits at higher premiums. They offer no care coordination, no chronic care management, no pay-for-performance incentives. They have no way to control costs. They just write out checks.

Because Medicare Advantage negotiates payment levels and saves money through bulk purchasing, inpatient costs run 20 percent to 25 percent lower than under Medigap insurance. More patients are handled through outpatient care. X-rays and other radiation cost 10 percent to 20 percent less, and durable medical equipment like wheelchairs, walkers and oxygen bottles run one-fifth less than with conventional insurance policies.

So why is Obama so keen to cut Medicare Advantage? Here's a clue: AARP (the American Association of Retired Persons) does not sell Medicare Advantage. But it makes a vast amount of money selling Medigap coverage. AARP has had no higher political priority than to curb the Medicare Advantage program and replace it with Medigap insurance. The profit margins on Medigap are greater, and AARP has every intention of exploiting them with Obama's help. His price? AARP backing for his program.

The American Seniors Association (ASA), an alternative to AARP that represents hundreds of thousands of elderly, says, "It is outrageous that Medicare Advantage, a private program with premium assistance for seniors ... has come under attack." Stuart Barton, ASA president, notes that under Medicare Advantage, private healthcare companies "compete to provide care based on a negotiated price."

Obama's deal with AARP represents special interest politics at its worst. He has already negotiated a deal with the big drug companies to get their support for his bill (and their advertising bucks to promote it) in return for guaranteeing that the cuts in their prices and profits will be small. And, by cutting Medicare Advantage, he signed up the AARP too.

Obama plans to slash the premium subsidies to low income elderly for Medicare Advantage coverage. This would drive up the premiums and drive many poor seniors into Medigap coverage. And then, most cynically, he would take the money he saves on shortchanging poor old people and use it to subsidize the policies of people in their 20s, 30s, 40s and 50s who are, by definition, not poor (and thus not eligible for Medicaid).

Barack Obama and sneaky congressional leaders don't want you to know what's in ObamaCare. They have made it clear that they will hide all the details from you. When Sen. Jim Bunning offered an amendment that would have required that the language of the bill be made available to the American people 72 hours prior to a vote, Democrats on the Senate Finance Committee squashed it.

It's becoming more apparent that Obama and his allies in Congress don't want the American people to know or read or hear anything negative about ObamaCare. They are willing to shut down debate by any means necessary. We believe they are laying the groundwork to enact ObamaCare in the dead of night, under the cover of darkness before any of us are any the wiser.

Michael Franc, writing for the Heritage Foundation's blog, The Foundry, gives us the details: "During the Senate Finance Committee mark up of the Baucus health bill... Senator Bunning of Kentucky put forth an innovative amendment. This amendment stipulated that before voting on the measure in Committee, legislative language would have to be accessible to the public for 72 hours and that the non-partisan Congressional Budget Office (CBO) would need to publish an official tally of how much this bill will cost the American people and what the real impact will be on health costs."

Franc continued: "The amendment failed 11-12 on nearly a party line vote. Senator Blanche Lincoln (AR) was the sole Democrat to support this attempt at transparency. The bottom line: when the committee completes its work on this re-make of one-sixth of our economy, Senators will have voted on a phantom - a bill that does not exist with costs that are unknowable until, that is, the unelected legislative draftsmen write the real bill in some back room on Capitol Hill."

It's bad enough when our federal legislators vote on bills they have not even bothered to read. But to actually start "negotiations" on 200 pages of notes and ideas on a bill that has not even been written? Then in the heights of arrogance, they squash an amendment that would require them to give you 72 hours to read what will likely be thousands of pages before they vote on it.

But what's even worse, Obama is trying to muzzle, and intimidate, those who dare to speak out against ObamaCare. Managed care provider Humana published a letter to its members warning them of potential drastic cuts to Medicare (specifically the Medicare Advantage program) under ObamaCare. It urged its members to contact Congress. Specifically, Humana said; "if the proposed funding cut levels [in the current health care legislation] become law, millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable."

It was a very valid point to raise as such proposals are on the table, and it makes all the sense in the world to alert people to what is going on and motivate them to call their elected officials. But it didn't take the long for our government to come down hard on Humana. The Department of Health and Human Services (HHS) initiated an investigation and sent an ominous gag-order to Humana: "As we continue our research into this issue, we are instructing you to immediately discontinue all such mailings to beneficiaries and to remove any related materials directed to Medicare enrollees from your Web sites."

And Sen. Max Baucus demanded that the Centers for Medicare and Medicaid Services launch an "investigation" against Humana as well, claiming the letter put forth "false information." Baucus snidely asked, "Does the First Amendment include lies?"

Of course, there's just one small problem with Baucus' ranting accusation. Humana was voicing an opinion that was well grounded in fact. Bob Ellis with Dakotavoice.com wrote: "Even the Congressional Budget Office (CBO) confirms what the White House doesn't want to get out, with CBO head Douglas Elmendorf telling the Senate this on Tuesday."

If nothing else that has transpired up to this point has convinced you that ObamaCare must be rejected, these shenanigans should.

1 comment:

Rawman2k
said...

Obama care!! I hope not. I use the VHA and it is a sample of what all will get. I was diagnosed with "Severe Degenerative Arthritis" of the left hip in February. The Dr looked at me and asked how I was able to walk, and stated I needed a total hip replacement as soon as possable. The Orthopedic Clinic refused to put me on the waiting list until I quit smoking cigerettes for at least a month. I was sent to the lab to have blood drawn for a Nicotine test. Now I am on the list as of May 29th 2009. When will I get the surgery? I was told in August it would be 6 to 9 months down the road. That is what a gov. run medical system is like. As for the electronic med record system---- good fun for the hackers out there.

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here